Healthcare Provider Details

I. General information

NPI: 1386493112
Provider Name (Legal Business Name): YOLEIVIS MAESTRE AVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 W SAINT JOHN ST
TAMPA FL
33607-2126
US

IV. Provider business mailing address

3224 W SAINT JOHN ST
TAMPA FL
33607-2126
US

V. Phone/Fax

Practice location:
  • Phone: 813-678-3573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-345805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: